Professor Nutt Urges New Thinking on Drugs

Mon 8th Nov 2010

"How irresponsible can you get?" crowed Peter Hitchens on the Today programme, bridling at Professor David Nutt's suggestion that illegal drugs be decriminalised and alcohol restricted. Somewhere, an adoring crowd of middle-England listeners smiled warmly, Hitchens’ rebuke to Nutt being, of course, a victory for common sense.

The only snag was that Professor Nutt didn’t make that suggestion. Nor does that suggestion appear at any point in the study he co-authored, the release of which on Monday triggered a shower of gloriously indignant invective, directed at nothing and nobody in particular. So continued the strange hysteria surrounding a deceptively simple issue.

David Nutt was dismissed a year ago, following his exasperated response to the government's equally quick dismissal of his committee's findings. His temerity, in suggesting that class C better reflected the harms inflicted by cannabis than class B, inspired Alan Johnson to sack him from the Advisory Council on the Misuse of Drugs (ACMD). Several colleagues resigned in protest. A year later, the Independent Scientific Committee on Drugs (ISCD) has risen from the ACMD's ashes, and produced a more nuanced study. 'Drug Harms in the UK: A Multicriteria Decision Analysis' responds directly to criticisms of its predecessor, 'Estimating Drug Harms', and widens the range of factors considered when determining the damage caused by drug abuse.

The new report applies multicriteria decision analysis (MCDA) to harms caused by the abuse of legal and illegal drugs. It found that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals, whereas alcohol, heroin, and crack cocaine were the most harmful to others. Overall, alcohol was the most harmful drug, with heroin and crack cocaine in second and third places. The report concluded: "the present drug classification systems have little relation to the evidence of harm," and that "aggressively targeting alcohol harms is a valid and necessary public health strategy."

These conclusions seem more measured than the "BAN BOOZE and LEGALISE CRACK" declarations that were splashed across the red tops on Monday morning. The study simply suggests that current classifications do not correspond to individual or collective harms. It stated that by no measure, save assumption, is alcohol the most suitable drug for widespread legal consumption. Nor is ecstasy (to pick one example) among the worst.

The next few days saw the media awash with hastily-arranged panels, interviews and phone-ins. Hitchens' appearance on Radio 4's 'Today' programme was emblematic of the bluster passing as public debate on the subject. Hitchens decried the study - published in medical journal The Lancet - for containing too much scientific language. He poured scorn on scientific method by dismissing its peer-review system at a stroke, and cheerily asserted that his common sense assumptions were worth more than 'the best science available'.

Hitchens' pointless ire at least showed the extent of the fierce hostility from some quarters to the possibility of even considering reform, let alone basing that reform on the latest evidence. This is not a uniquely British problem. Wednesday saw Californian voters reject Proposition 19, which sought to legalise personal cannabis-related activities, under the taxation and regulation of local government. Fears pervade both here and in the USA that any kind of relaxation of drug laws would increase their use, and ultimately increase harm to the individual and the community. While the ISCD’s new study paints a damning picture of the gulf between classifications and levels of harm, it can't predict the effect of decriminalisation on our modern society.

Fortunately for those with an interest in fact-based decision-making, Portugal decriminalised illicit drug use in July of 2001. Driven by rising heroin addiction and overcrowded prisons, the Portuguese government took a chance and tried something different. Nine years later, Hughes and Stevens published their study, 'What can we learn from the Portuguese decriminalization of illicit drugs?' in the Oxford Journal of Criminology. The authors had nine years of real-world data to consider. They found that since decriminalisation, illicit drug use among problematic users and adolescents had decreased; opiate-related deaths and infectious diseases had fallen; and the burden of drug offenders on the criminal justice system had been reduced.

The coalition is yet to truly show its hand on drug law reform. In response to the ISCD report, the Home Office declared: "Our priorities are clear - we want to reduce drug use, crack down on drug-related crime and disorder and help addicts come off drugs for good." The priorities may be clear but future policy has yet to become so. Some are optimistic, given David Cameron's refreshingly candid admissions about his past experiences with drugs. More encouraging still, the 2010 Liberal Democrat manifesto pledged to "always base drugs policy on independent scientific advice, including making the Advisory Council on the Misuse of Drugs completely independent of government." Sounds good.

But as a generation of prospective undergraduates are discovering this week, a pre-coalition Lib Dem election promise can be an illusory thing, prone to revision. What is certain, however, is that the ISCD has no intention of blithely accepting governmental disdain for its findings. And as binge drinking continues to weigh heavily on the health of the UK, the coalition government may yet find itself having to pay more attention to Nutt and co than its predecessor.